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Acute coronary syndromes can be a headache
  1. C Costopoulos
  1. Correspondence to Dr Charis Costopoulos, Department of Medicine, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK; ccostopoulos{at}


Ischaemic heart disease is a common cause of morbidity and mortality worldwide. Patients typically present with chest pain and breathlessness either on exertion or at rest. Cardiac ischaemia can also lead to headache, although this is very rarely its only manifestation. Headache is mostly associated with migraine, cluster and tension headache disorders. More sinister causes include subarachnoid haemorrhage, temporal arteritis, meningitis, venous sinus thrombosis as well as vertebral and carotid artery dissection. A case of headache is presented where the underlying cause was cardiac ischaemia, itself the result of triple vessel coronary artery disease. This, also referred to as cardiac cephalgia, should be suspected in the older patient with risk factors for atherosclerotic disease presenting with recent-onset headache. Diagnosis of this requires high clinical suspicion and is essential for correct patient management.

  • Acute coronary syndrome
  • cephalgia
  • headache
  • electrocardiogram
  • migraine, cardiac care, acute coronary syndrome
  • clinical assessment
  • ECG
  • emergency care systems
  • emergency departments
  • emergency care systems
  • emergency departments

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  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; not externally peer reviewed.